The latest CDC report shows an overall rise (from 8.9% to 13%) in
samples positive for H1N1 in Region 4 in the week 4 report, providing
additional evidence for the start of wave 3 in the United States.
Earlier media reports had described increases in various states in
region 4. Le Boehner children’s hospital in Memphis had seen an
increase in hospitalized patients and a high frequency were being admitted
to the ICU, where at least 2 of the 7 died.
One was from MS while then other was from TN. University
of North Carolina hospital also reported an increase in confirmed
H1N1 in college
students, and the North Carolina website showed an
increase in samples testing positive for H1N1 to 25%, the
highest level since mid-November when wave 2 was declining.

These sharp increases in region 4 raise concerns that these cases will
spread. Region 4 led the nation at the beginning of the fall
wave, which largely followed school openings. Many of the schools
in region 4 opened in August. The rise in positive patients in
region 4 raises concerns that wave 3 will be more severe, with an
associated increase in deaths.

Tamiflu resistant H1N1 with D225G/N was found in the Duke
fatal cluster in October/November increased concerns for more
fatalities. The three fatalities at Duke were in the same ward and
infected with the same H1N1, which had H274Y in NA and Y223H in HA.

Release of sequences from the severe cases in TN and NC would be useful.